Azoospermic patients who have no spermatozoa in their ejaculate, have the option to undergo retrieval of sperm from the epididymis or testis. It is a procedure performed under local or general anaesthetic.
The sample obtained is analyzed and can be prepared to be used on the day of the egg collection for fertilisation, it can be cryopreserved for future use or a combination of both. Once the spermatozoa have been isolated, fertilization can be achieved through the ICSI procedure.
What are the different procedures for surgical sperm retrieval?
- PESA (Percutaneous Epididymal Sperm Aspiration): this procedure involves the insertion of a needle into the epididymis, followed by the aspiration of fluid. The fluid is then analyzed under the microscope to assess sperm content and motility.
- MESA (Microsurgical Epididymal Sperm Aspiration): This is a microsurgical technique used to identify optimal areas of the epididymis to remove small samples of epididymal fluid, using high-power optical magnification. This is followed by laboratory handling and processing with the eventual extraction of spermatozoa from the fluid.
- TESA (Testicular Sperm Aspiration): This procedure involves the insertion of a needle into the testis and the aspiration of both fluid and tissue. The sample is then analyzed under the microscope.
- TESE (Testicular Sperm Extraction): Also called testicular biopsy, involves a small surgical incision in the testis and removal of testicular tissue to be processed in the laboratory for the isolation of spermatozoa from the seminiferous tubules.
A small sample from the testicular biopsy can also be sent for histological evaluation, for detailed assessment of spermatogenesis.